Arterial blood gas results rarely influence emergency physician. Arterial blood gas analysis and acidbase balance disorders. A study conducted in illinois at freeport health network memorial hospital and swedish american hospital demonstrated that a computerbased module helped nurses to learn abg interpretation. In this guide, we will teach you the eight 8 steps on how to interpret and analyze arterial blood gas abg results using the tictactoe method. Diabetes association has revised its position on ketone analysis in favor of serum testing. Prognostic value of venous blood gas analysis in patients with. It is an essential part of diagnosing and managing a patients oxygenation status and acidbase balance. The clinician, by the end of the roundtable, will be able to analyze abgs with ease and label what type of acidbase disturbance is present. The use of blood gas analysis was never intended for dka management. The available literature, primarily in patients with mild to moderately severe acidosis, does not. Pdf the value of venous blood gas analysis in the diagnosis of. Pdf use of sodium bicarbonate and blood gas monitoring in. For example abgs with an alkalemic ph may exhibit respiratory acidosis and metabolic alkalosis. Although not an exhaustive list, it attempts to outline the main headings for possible pathology it covers acidbase disturbance, respiratory failure, and a small summary for some other derangements.
These disorders are termed complex acidbase or mixed disorders. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl. What are the jbds guidelines regarding the use of arterial. Abg interpretation a guide to understanding abgs geeky medics. If you received information from your chem 7 or chem 20 that the serum co2 on your patient is low, there is acid in the body that needs to be buffered. The arterial blood gas abg analyzer interprets abg findings and values. The p a co 2 is abnormal in the opposite direction of the cause of acidosis in an attempt to correct, or compensate for, the metabolic acidosis.
Interpreting an arterial blood gas abg is a crucially important skill for respiratory therapists. The net deviation in ph will indicate whether an acidosis or an alkalosis is present. However, the more complicated and in some ways more important part of abg analysis is ph regulation. Physiological approach to assessment of acidbase disturbances. Indications, interpretations, and clinical applications m etabolic derangements and respiratory distress are common presenting problems in emergency medicine. Diabetes mellitus is the name given to a group of conditions whose common. This guide provides a structured approach to abg interpretation, including several worked. List the types of samples that can be analyzed for blood gas and analyte concentrations.
In patients with dka, arterial blood gases abgs frequently show typical manifestations of metabolic acidosis, low bicarbonate, and low ph less than 7. Practically speaking, the blood gas doesnt help diagnose dka. However, its a crucial skill for nurses, physicians, respiratory therapists, and nursing students to learn. Education arterial blood gas abg interpretation determining acidosis and alkalosis. Arterial blood gas abg interpretation determining acidosis and alkalosis. Venous blood gas measurements accurately demonstrate the degree of acidosis of adult ed patients presenting with diabetic ketoacidosis. Diagnosis of metabolic acidbase disorders emcrit project.
Blood gas and critical care analyte analysis chapter objectives 1. Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. Arterial blood gases abg can be difficult and confusing to understand at first. Abg interpretation is especially important in critically ill patients because it helps the healthcare team determine the best course of action in regards to treating the patient. Causes include renal failure, diabetic ketoacidosis, lactic acidosis. Arterial blood gas abg interpretation is something many medical students find difficult. Interpreting an arterial blood gas abg is a crucial skill for physicians, nurses, respiratory. Interpreting and using the arterial blood gas analysis. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Arterial blood gas analysis is an essential part of diagnosing and managing a patients. This diagnosis should be based on analysis of the metabolic derangements in. It reflects unmeasured anions negatively charged ions such as proteins, sulfates, phosphates etc.
It occurs predominantly in people with type 1 diabetes, although it is occasionally seen in type 2 diabetes or gestational diabetes as well. Interpretation of arterial blood gases abgs david a. The cause of the acidosis is the hco3, which is the metabolic component of the arterial blood gas. In order to best truly learn abg interpretation, you must first.
Each case is then followed by an explanation of the acidbase status, the oxygenation status and a summary of the patients clinical picture. Accurate and timely interpretation of an acidbase disorder can be lifesav. Woodruff, msn, rnbc, cns, cmsrn, cen 6 easy steps to. Also, another key thing to look for with dka is an elevated anion gap. Analysis of the metabolic ph disorders is usually the most important component and frequently sufficient to guide treatment. The total number of diabetic ketoacidosis was 14 patients 28. Short educational modules for nurses in arterial blood gas analysis can have significant impact on improving the knowledge of the nurse. When one thinks of abg analysis, oxygenation may come to mind first. Urine analysis appearance or color specific gravity ph leukocyte esterase nitrites urobilinogen bilirubin glucose ketones. The investigation is relatively easy to perform and yields information that can guide the management of acute and chronic illnesses. This tictactoe technique involves a few charts to help you visualize abgs. Serial arterial blood gas measurements and intravenous sodium bicarbonate are often used to assess and correct acidosis associated with diabetic ketoacidosis. An arterial blood gas abg analysis can tell you about a patients oxygenation, acidbase balance, pulmonary function, and metabolic status.
Arterial blood gas interpretation felicia ratnaraj internal medicine pgy 3 pm report. University of pittsburgh medical center page seven d. The final classification of these abg results is partially compensated metabolic acidosis. Use of sodium bicarbonate and blood gas monitoring in. Arterial blood gas abg interpretation is something many medical students find difficult to grasp weve been there. Insulin has several actions, depending on the concentration present in the circulation. Diabetic ketoacidosis, sodium bicarbonate, blood gas analysis, acidosis, ketosis, ketone bodies, hyperglycemia. Pdf diabetic ketoacidosis dka is a severe and toocommon. Respiratory acidosis respiratory acidosis is defined as a ph less than 7. A recent survey revealed that 9 % of type 1 diabetics suffered an episode of dka at least once during the previous 12 months. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on youtube. Body will not overcompensate when it comes to acidbase balance so.
This information indicates a patients acidbase balance, the effectiveness of their. Abg quick interpretation parameter acidosis normal alkalosis reflects ph 7. Use of sodium bicarbonate and blood gas monitoring in diabetic. The sensitivity and specificity of the vbg and electrolytes for diagnosing dka was 92. This patient has diabetic ketoacidosis dka, but such patients may have other acidbase disaorders present, such as.
The hydrogen ions are buffered by desaturated hemoglobin, and hco3 is transported out of the eryth rocytes into the plasma figure 63. Determine the cause of the acidosis or alkalosis by looking at the pco2 and hco3if ph acidosis. The interpretation of arterial blood gases australian. The real value of an abg comes from its ability to provide a. Weve created this guide, which aims to provide a structured approach to abg interpretation whilst also increasing your understanding of each results relevance. Abg interpretation steps to abg interpretation step 1. Diabetic ketoacidosis dka is a kind of hyper glycemia caused by metabolic disorders of sugar, protein and fat because of severe insulin. Interpretation of the arterial blood gas selflearning packet. Anion gap this value is used in metablic acidosis to find the cause. Arterial blood gas analysis abg, is a test that measures the amount of oxygen o2 and carbon dioxide co2 in the blood, as well as the acidity ph of the blood. Blood gas analysis is a commonly used diagnostic tool to evaluate the. Diabetic ketoacidosis dka, by contrast, is an acute complication of diabetes which evolves over a period of less than 24 hours and results directly from insulin deficiency. But it is often encountered that many students dont know how to read abg, and thats why we are providing arterial blood gas.
In the assessment of the level of acidosis in a dka patient, an arterial blood gas abg has long been thought of as much more accurate than a venous blood gas vbg and thus necessary in evaluating a dka patients ph and hco3 level, two values often used to direct treatment decisions. Arterial blood gas analysis is used to measure the ph and the partial pressures of oxygen and carbon dioxide in arterial blood. Abg interpretation a guide to understanding abgs geeky. An abg is the most accurate representation of a patients clinical status and correct interpretation can lead to quicker and more accurate changes in the. Diabetic ketoacidosis dka is the hallmark of absolute insulin deficiency. Complete analysis of ph status requires blood gas analysis, but all you need to determine the metabolic ph disorders is an electrolyte panel. Abg vbg isnt needed to evaluate metabolic ph disorders. Once youve mastered this technique, youll be doing actual abg interpretation.
A lecture on the physiology of normal acidbase regulation, including a discussion of the bicarbonate buffering system, the hendersonhasselbalch. Determine the ph if ph is acidosis is present if ph is 7. A venous blood gas often correlates well with arterial blood gas findings except for pao2 unless values are extremely abnormal, and can often be used successfully as a screening tool. Explain the types of errors that can occur with blood gas analysis.
Pdf comparison of arterial and venous blood gas values in the. Arterial blood gas case questions and answers in the space that follows you will find a series of cases that include arterial blood gases. This page focuses on providing some possible causes for the various disturbances that may be seen on an abg. Normal acidbase regulation abg interpretation lesson 2. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Arterial blood gas analysis is a frequently used and extremely useful clinical tool.
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